U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

This is a general description of the plan changes. This page is not an official statement of benefits. For that, go to the Benefits descriptions in the Plan Brochure. Also, we edited and clarified language throughout the brochure; any language change not shown here is a clarification that does not change benefits.

• Your share of the non-Postal premium under the High Option will increase by 13.5% for Self Only or 13.8% for Self and Family. Under the Standard Option, your share of the premium will increase by 10% for Self Only or 10% for Self and Family.

• United Behavioral Health network is no longer a preferred provider network for mental health and substance abuse services.

• The separate calendar year mental health-substance abuse deductible has been eliminated. All mental health and substance abuse services by PPO providers and inpatient or outpatient professional mental health and substance abuse services by non-PPO providers are now subject to the same calendar year deductible as medical expenses. Inpatient hospital services by non-PPO providers and outpatient intensive day treatment by non-PPO providers are still subject to the separate $500 calendar year deductible per person.

• The separate PPO mental health and substance abuse catastrophic out-of-pocket maximum has been eliminated. All mental health and substance abuse services by PPO providers are subject to the same catastrophic out-of-pocket maximums as medical services. Non-PPO mental health and substance abuse services are still subject to the separate $8,000 catastrophic out-of-pocket maximum

• It is no longer necessary to obtain approval of outpatient mental health and substance abuse professional services to receive PPO benefits from PPO providers. You must still obtain approval of inpatient services and outpatient intensive day treatment by PPO providers to receive PPO benefits. You must also still pre-certify inpatient hospital services by non-PPO providers. The medical necessity of your admission to a hospital or other covered facility including in-network outpatient intensive day treatment for mental health or substance abuse must be precertified. Emergency admissions must be reported with two business days following the day of admission even if you have been discharged. Otherwise, the benefits will be reduced. See Section 3 for details.

• All medically necessary sonograms during pregnancy are covered.

• The copayment for single source brand name drugs for Non-Medicare members is now $25 at network retail pharmacies and $45 at Home Delivery.

• The copayment for multisource brand name drugs for Non-Medicare members is now $40 at network retail pharmacies and $60 at Home Delivery.

• We have clarified that no computer programs are covered.

• We have clarified that we do not cover bioelectric computer programmed prosthetic devices.

• We have clarified that colonoscopies are covered as routine screenings.

• We have clarified that bone density tests are covered for women over 65 and women over 60 who are at high risk.

• We have clarified that average wholesale pricing data is used to determine plan allowable for prescription drugs.

• We have clarified that state law may prohibit the substitution of generic drugs for some brand name drugs.

• We have clarified the subrogation language.

• We have expanded the instructions on how to file foreign claims.